Article

Lorig KR, Sobel DS, Ritter PL, Laurent D, Hobbs M. Effect of a self-management program on patients with chronic disease

Stanford University School of Medicine, Calif, USA.
Effective clinical practice: ECP 11/2000; 4(6):256-62.
Source: PubMed

ABSTRACT

For patients with chronic disease, there is growing interest in "self-management" programs that emphasize the patients' central role in managing their illness. A recent randomized clinical trial demonstrated the potential of self-management to improve health status and reduce health care utilization in patients with chronic diseases.
To evaluate outcomes of a chronic disease self-management program in a real-world" setting.
Before-after cohort study.
Of the 613 patients from various Kaiser Permanente hospitals and clinics recruited for the study, 489 had complete baseline and follow-up data.
The Chronic Disease Self-Management Program is a 7-week, small-group intervention attended by people with different chronic conditions. It is taught largely by peer instructors from a highly structured manual. The program is based on self-efficacy theory and emphasizes problem solving, decision making, and confidence building.
Health behavior, self-efficacy (confidence in ability to deal with health problems), health status, and health care utilization, assessed at baseline and at 12 months by self-administered questionnaires.
At 1 year, participants in the program experienced statistically significant improvements in health behaviors (exercise, cognitive symptom management, and communication with physicians), self-efficacy, and health status (fatigue, shortness of breath, pain, role function, depression, and health distress) and had fewer visits to the emergency department (ED) (0.4 visits in the 6 months prior to baseline, compared with 0.3 in the 6 months prior to follow-up; P = 0.05). There were slightly fewer outpatient visits to physicians and fewer days in hospital, but the differences were not statistically significant. Results were of about the same magnitude as those observed in a previous randomized, controlled trial. Program costs were estimated to be about $200 per participant.
We replicated the results of our previous clinical trial of a chronic disease self-management program in a "real-world" setting. One year after exposure to the program, most patients experienced statistically significant improvements in a variety of health outcomes and had fewer ED visits.

Download full-text

Full-text

Available from: Diana Laurent
  • Source
    • "Several studies have highlighted that higher PE positively influences disease management leading to improvement of health behaviors [32] [33] [34] [35] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Asthma self-management has been recognized as an essential factor for the improvement of asthma outcomes and patients' quality of life (WHO, 2013). Likewise, empowerment and health literacy have been noted as important elements for the management of chronic diseases. To study the influence of health literacy and empowerment on asthma self-management. This cross-sectional study used a self-reported questionnaire assessing health literacy, judgment skills, empowerment, and asthma self-management; 236 patients were recruited from medical offices in Switzerland and Italy. Judgment skills (B=2.28, p<0.001) and empowerment (B=0.19, p<0.05) have a significant and positive influence on several asthma self-management practices such as use of medicines, timely medical consultation, and asthma triggers control whereas health literacy (B=-0.15, p<0.175) appeared to have a negative effect on self-management practices. However, this was not significant. These findings suggest that empowered patients with adequate judgment skills carry out key self-management tasks more appropriately, which in turn will potentially result in better asthma control. This study recommends that both empowerment and judgment skills should be addressed in patient education as they serve as essential motivators to engage patients in these behaviors. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Apr 2015 · Patient Education and Counseling
  • Source
    • "The researcher discussed diabetes management strategies and evaluated and updated the action plan with the participants at each intervention visit. This problem-based, patient-focused approach was consistent with nursing case management and diabetes self-management interventions (Lorig, Ritter, & Gonzales, 2003; Lorig et al., 2001). The collaborative action plan included the identified health issues and behavior change strategies to manage diabetes. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: The study purpose was to evaluate the feasibility of a chronic disease self management/case management intervention for adults experiencing homelessness and diabetes and the ability to retain subjects. Methods: Participants with type 2 diabetes were recruited at a homeless clinic and a subset received the intervention. Analysis included calculating a retention rate and evaluating the intervention implementation process. Results: Of the nine participants, five were retained for 12 weeks and two of three participants completed the full intervention. Conclusions: Study retention is feasible for adults experiencing homelessness. Further intervention refinement is needed to address relevancy of content and time constraints.
    Full-text · Article · Oct 2014 · Journal of Community Health Nursing
  • Source
    • "This The significance of self-care and selfmanagement to optimise treatment and prevent further disease progression is extremely important. There is an emergent body of evidence suggesting that, when compared with no intervention (e.g. standard care), selfmanagement approaches can provide benefits for participants by increasing knowledge, performance of self-management behaviours and self-efficacy (Lorig et al, 2001; Barlow et al, 2002), with a decrease in the need for unplanned care (Lorig et al, 2001; Purdy, 2010). Living with a long-term condition such as COPD, and managing symptoms and self-care, can be impeded by the development of depression, resulting in the exacerbation of physical symptoms and emotional distress (Wright et al, 2011). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: People with chronic obstructive pulmonary disease (COPD) have a high prevalence of anxiety and depression, which can have an impact on their symptoms and the way they manage their condition. Intervention that takes psychological distress into account may lead to better outcomes than simple advice-giving. Aim: To explore the feasibility of integrating psychological screening and intervention into nurse-led reviews of patients with COPD. Method: Nurses were given training on a pathway developed for patients with COPD. This included screening for depression and anxiety and assessing their severity; providing self-management education by means of a motivational approach; and offering pulmonary rehabilitation. Results: The nurses' level of confidence increased following training. Patients were accepting of the screening process and felt more able and motivated to manage their condition after the intervention. Eleven of the 35 patients that took part in the study period had evidence of anxiety and/or depression. Out of a total of 16 patients eligible for pulmonary rehabilitation, 12 agreed to referral. Of these, three patients were seen by their GP, one was started on antidepressants, and one was referred to the psychology service. Conclusion: Training practice nurses to screen for depression and anxiety, and to offer self-management education using a motivational interviewing approach, increased the reported capability and motivation of patients with COPD to manage their condition. It may also improve the uptake of pulmonary rehabilitation. Use of this pathway does not place a burden on other care providers or greatly increase prescribing costs.
    Full-text · Article · Aug 2014 · British journal of nursing (Mark Allen Publishing)
Show more